Transitions to Family Caregiving and Its Impact on Health Indicators

 描述(由申请人提供)：老年人口的增长，许多致残疾病的流行，以及机构护理的高昂费用，对家庭成员提出了向残疾成年人提供非正式照料服务的巨大需求。以前的许多研究都将护理描述为一种慢性压力经历，与较差的健康状况以及炎症和免疫功能受损的生物标记物指标有关。然而，现有的绝大多数研究都是基于便利样本和横断面比较，相对较少的关于照看的研究使用了基于总体的样本或前瞻性地考察了个体参与者向照看角色的转变。这项拟议的研究将确定在参与一项大型、前瞻性的流行病学研究时，从非照料角色转变为家庭照料关系的个人。中风的地理和种族差异原因(CONTS)项目是一项正在进行的流行病学研究，截至2015年5月31日，有超过17,800名活跃的中老年参与者参与。试点数据表明，这些参与者中有1,200多人已从(8-12年前)基线上的非照看角色过渡到目前的非正式家庭照看角色。血清样本是从最初的家庭护理评估中收集和存储的，后续的血清样本现在正在收集，作为第二次家庭护理评估的一部分。我们建议从这两个方面的居家评估中确定并招募300名已经过渡到家庭照顾者角色的参与者，以及谁继续在第二次居家评估中担任照顾者。我们会将这些照顾者与300名单独匹配的非照顾者进行比较。多步骤匹配和协变量调整程序将被用来控制许多潜在的混杂变量，包括人口统计学、社会经济地位、既往健康状况和家庭关系因素。研究人员将比较一组炎症生物标记物(如CRP、IL-6、d-二聚体、肿瘤坏死因子-R1)、健康生物标记物(如血脂、HgA1c)和自我报告的健康结果指标(如与健康相关的生活质量、抑郁症状、健康行为)在10年间的变化。重要的分组比较将包括重点关注30%的照顾者，他们预计将照顾患有阿尔茨海默病或其他形式痴呆症的家庭成员。拟议的护理过渡项目将是有史以来第一项基于人群的研究，内容是过渡到护理角色对基于血清的生物标记物和其他重要的健康相关结果的影响。将提供关键的新知识，以更好地了解非正式护理对健康的影响，这将在未来几年成为更重要的医疗保健资源。

 DESCRIPTION (provided by applicant): The growth of the older adult population, increased prevalence of many disabling conditions, and high costs of institutional care are placing heavy demands on family members to provide informal caregiving services to adults with disabilities. Many previous studies have characterized caregiving as a chronic stress experience associated with poorer health and biomarker indicators of inflammation and compromised immunity. However, the vast majority of existing studies have been based on convenience samples and cross-sectional comparisons, and relatively few studies of caregiving have used population-based samples or prospectively examined transitions into the caregiving role within individual participants. The proposed study will identify individuals who have transitioned from a non-caregiving role into a family caregiving relationship while participating in a large, prospective, epidemiological study. The REasons for Geographic And Racial Differences in Stroke (REGARDS) project is an ongoing epidemiological study with over 17,800 active middle-aged and older participants as of May 31, 2015. Pilot data suggest that over 1,200 of these participants have transitioned from a non-caregiving role at REGARDS baseline (8-12 years ago) into an informal family caregiving role at the present time. Serum samples were collected and stored from an initial REGARDS in-home assessment, and follow-up serum samples are now being collected as part of a 2nd REGARDS in-home assessment. We propose to identify and enroll 300 participants from REGARDS who have transitioned into a family caregiving role between these two REGARDS in-home assessments and who continue to be caregivers at the 2nd in- home assessment. We will compare these caregivers to 300 individually-matched non-caregivers. A multi- step matching and covariate-adjustment procedure will be used to control for many potential confounding variables including demographics, socioeconomic status, prior health status, and family relationship factors. Changes over a 10-year period on a set of inflammatory biomarkers (e.g., CRP, IL-6, d-dimer, TNF-R1), health biomarkers (e.g., lipids, HgA1c), and self-reported health outcome measures (e.g., health-related quality of life, depressive symptoms, health behaviors) will be compared between incident caregivers and matched non- caregivers. Important subgroup comparisons will include a focus on the 30% of caregivers who are expected to be caring for a family member with Alzheimer's disease or another form of dementia. The proposed Caregiving Transitions Project will be the first population-based study ever conducted on the impact of transitioning into a caregiving role on serum-based biomarkers and other important health-related outcomes. Critical new knowledge will be provided for better understanding the health impact of informal caregiving, which will be an even more critical healthcare resource in the coming years.